NUTRITION CARE LAGS IN HOSPITALS: STUDY

Almost 60 percent of the patients in Illinois hospitals suffer from some degree of malnutrition, according to the largest study ever conducted on the nutritional status of hospital patients.

The findings are shocking because they mean that the health of thousands of hospital patients is routinely being compromised and that there are substantial gaps in the overall quality of nutrition care in hospitals, said Dr. Savitri Kamath, chief of the University of Illinois` department of nutrition and medical dietetics.

''The results are very disturbing,'' she said, ''because malnutrition can be easily detected and corrected and it can improve the outcome of patients.''

The study, conducted by researchers at the U. of I., the University of Chicago and Children`s Memorial Hospital, involved 3,172 patients at 33 hospitals, 19 of which are in Chicago.

The study disclosed that many hospitals do not perform even the most fundamental measurements that would permit quick assessments of patients`

nutritional status. This includes failure to analyze blood tests and to take height and weight measurements.

Adequate blood values, which are used to measure protein-calorie malnutrition, were available for only 41 percent of the patients. The most dramatic finding was that of these patients, 58 percent were at ''nutritional risk'' because they had one or more indicators of malnutrition.

''The thing that is so surprising is that malnutrition among hospital patients still is so widespread, even after the problem was first uncovered in studies done in the early 1970s,'' said Dr. Marilyn Lawler, director of clinical nutrition services at the University of Chicago.

The large-scale Illinois study was undertaken because earlier studies were criticized as being too small and not representative of hospitals in general, Kamath said.

The findings indicate that malnutrition among hospital patients is a nationwide problem that has long been neglected, she said.

''This is a major problem because malnutrition is likely to increase a patient`s risk of complications and death and to prolong hospital stays,''

Lawler said.

Other studies have shown that the body`s immune system is impaired by malnutrition and patients are more likely to get infections, have poorer healing of wounds and to be less able to withstand the rigors of surgery and other treatments, she said.

The researchers urged hospitals to establish routine nutritional screening programs in order to substantially improve the health of patients, speed up recovery and reduce costs from unnecessary hospital delays and complications.

''When you improve a patient`s nutritional health, you reduce the risk of complications. And that could result in tremendous savings,'' said Alice Smith of Children`s Memorial.

Because of the study, Children`s Memorial began routine screening of all patients last October and found that 37 percent were at nutritional risk, she said.

Screening, which costs only 90 cents per patient, involves reading blood tests that are routinely taken of almost all patients for other purposes, evaluating height and weight, listing the diagnosis and determining whether there was a sudden weight loss, she said.

The program already has resulted in a 30 percent reduction in the length of stay for children suffering from intractable diarrhea, Smith said. Almost all of these patients were found to be malnourished, she said. Children now are given nutritional support upon entering the hospital, she added.

''Nutritional screening is not expensive nor is it difficult, because trained dietitians already are available at most hospitals,'' Smith said.

Correcting nutritional imbalances also is relatively inexpensive, and most people can be upgraded to normal nutritional levels within about a week, Lawler said.

It may be as simple as making sure a person gets adequate amounts of protein and calories in his regular meals, or it may involve nutritional supplements in the form of milk shake-like drinks packed with protein, calories, vitamins and minerals, she said. In some cases nutritional support is provided through intravenous feeding.

Serum albumin levels indicate the amount of protein in the blood; below-normal levels signify malnutrition, she said. A total lymphocyte count determines the level of white blood cells, a major part of the body`s immune defense system. Low levels, which indicate impaired immunity, often are caused by malnutrition. Hemoglobin values measure red blood cells, which are used to determine whether a patient is anemic.

''When any one of these factors is below normal levels, you can get an increase in complications and deaths,'' Lawler said.

For total lymphocyte counts, the researchers found that 46 percent of the readings were below normal. Almost 30 percent of the hemoglobin values were below normal, as were 12 percent of the serum albumin levels.